Provider Demographics
NPI:1144106964
Name:SAMPERIO, KEVIN (PTA)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:
Last Name:SAMPERIO
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:72880 FRED WARING DR STE B7
Mailing Address - Street 2:
Mailing Address - City:PALM DESERT
Mailing Address - State:CA
Mailing Address - Zip Code:92260-9375
Mailing Address - Country:US
Mailing Address - Phone:760-340-4050
Mailing Address - Fax:
Practice Address - Street 1:72880 FRED WARING DR STE B7
Practice Address - Street 2:
Practice Address - City:PALM DESERT
Practice Address - State:CA
Practice Address - Zip Code:92260-9375
Practice Address - Country:US
Practice Address - Phone:760-340-4050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-15
Last Update Date:2025-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA52675225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant